eating well during and after your cancer treatmentpatient & caregiver education eating well...

PATIENT & CAREGIVER EDUCATION

Eating Well During and After Your CancerTreatmentThis information will help you maintain your nutrition during and after your cancer treatment.

Good nutrition is very important for people with cancer. There may be some nutritional changes you can

make now that will help you during treatment. Start by eating a healthy diet. This can increase your

strength, help you maintain your weight, and help you fight infection. It may even help with the side effects

of treatment.

My Plate

My Plate is a picture of a place setting that shows what a healthy meal should

look like. It includes the 5 food groups that are the building blocks of a

healthy diet. These groups include whole grains, fruits, vegetables, lean

proteins, and low-fat dairy products. Foods that are high in fat and sugar

should be limited or avoided. For more information about the My Plate

guidelines, go to: www.choosemyplate.gov.

The side effects of cancer and cancer treatment can make it hard to eat. When this happens, it may be

difficult for you to follow the My Plate guidelines. You may need to change your eating plan if you can't eat

certain foods.

How Treatment Can Affect Your Eating

SurgeryIf your weight is below normal, you may have to gain weight before your surgery. In this resource, you will

find suggestions for how to eat more calories and protein. This can help you put on weight before surgery

and help you heal afterward.

If you are having mouth, throat, or stomach surgery, it can be hard for you to eat. You may need to get

nutrition in other ways, such as intravenously (through a vein), through a tube in your nose, or through a

tube in your stomach or the upper part of your intestine.

RadiationRadiation treatment to the head and neck can cause trouble swallowing, taste changes, dry mouth, or

soreness in the mouth or throat. Treatment to the chest can cause you to have trouble swallowing.

Treatment to the stomach, abdominal (stomach) area, or pelvis can cause nausea and vomiting, diarrhea,

cramps, and bloating.

ChemotherapyMany chemotherapy medications can affect your digestive system. They can cause nausea and vomiting,

decreased appetite, diarrhea, constipation, weight gain or loss, and changes in the taste or smell of food.

Eating Well During and After Your Cancer Treatment 1 of 22

http://www.choosemyplate.gov

ImmunotherapyImmunotherapy stimulates your body's immune system to fight cancer cells. Side effects include:

Nausea and vomiting

Diarrhea

Sore mouth

Dry mouth

Weight loss

Changes in the taste of food

Muscle aches

Fatigue

Fever

Hormonal therapyHormonal therapy uses medications that stop your body from making some hormones or change the way

they work. Side effects include changes in appetite, water retention, weight gain, and nausea and vomiting.

General Nutritional Guidelines

Vitamin and mineral supplementsYou can get 100% of your daily recommended nutrients from a well-balanced diet. If your diet is lacking,

vitamins and mineral supplements can help. Some people take large amounts of antioxidants, herbs, or

extra vitamins and minerals because they think it will help cure their cancer. This has not been shown to

help in the fight against cancer. During some kinds of cancer treatments, this can actually harm you. If you

are thinking about doing this, talk with your doctor first. A dietitian or pharmacist can also answer any

questions you have.

Clinical trials are research studies. They are done to test new

Therapies

Drugs or drug combinations

Methods of delivery

Dosages and timing

Some trials test vitamins or supplements. This is done to see if they have an effect on a type of cancer.

One trial is looking at the effects of high-dose vitamin D on metastatic colorectal cancer (colorectal cancer

that has spread to other areas of the body). To find out more about this or other clinical trials:

Visit the clinical trials section of the National Cancer Institute (NCI) website

at: www.cancer.gov/clinicaltrials

Call the NCI Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

Alternative and complementary therapiesYou may have read or heard about alternative therapies. Sometimes, these are used in place of


http://www.cancer.gov/clinicaltrials

conventional treatment. The safety and effectiveness of many of these treatments have not been

confirmed. We do know that some are not safe. Others can interfere with your chemotherapy or radiation

therapy. Talk with your doctor or nurse before you start any of these treatments. It could

make your treatment less effective and cause harm.

Complementary therapies can help people cope with some of the symptoms of cancer and the side

effects of treatment, such as nausea, vomiting, and fatigue. They can also help reduce stress and promote a

feeling of well-being. They do not cause any harm. Complementary therapies include:

Reflexology

Meditation

Massage

Music therapy

Yoga

T'ai Chi

Acupuncture

Reiki

Food safetyDuring cancer treatment, your body has a hard time fighting off infection. It is more important than ever

to make sure that the foods you're eating are safe. This will reduce your risk for foodborne illnesses and

other infections. Below are 4 simple steps for food safety.

Wash your hands and surfaces often

Before and after preparing food, wash your hands well with soap and warm water for 15 to 20

seconds.

Wash your cutting boards, dishes, utensils, and counter tops with soap and hot water when preparing

each food item and before moving on to the next food item.

Consider using paper towels to clean up kitchen surfaces. Replace used sponges and dishtowels with

clean ones often.

Wash all fruits and vegetables well before eating, even if you are going to peel off the skin.

Separate raw foods from other foods

Separate raw foods (e.g., raw meat, poultry, and fish) from other foods in your grocery shopping cart,

grocery bags, and in your refrigerator.

Use 1 cutting board for fresh produce and a separate one for raw meat, poultry, and fish.

Cook foods to proper temperatures

Avoid eating any foods that have raw or undercooked eggs, meat, poultry, or fish.

Use a thermometer to measure the internal temperature of cooked foods. Make sure that meat,

poultry, fish, egg dishes, and casseroles are cooked to the internal temperature shown in the chart

below:


Food Item Internal Temperature

Fish 145° F (62.8° C)

Beef, pork and lamb steaks, chops androasts

145° F (62.8° C)

Egg dishes 160° F (71.1° C)

Ground beef 160° F (71.1° C)

Chicken breast 165° F (73.9° C)

Whole poultry (e.g., chicken, turkey) 165° F (73.9° C)

Ground poultry 165° F (73.9° C)

Leftovers and casseroles 165° F (73.9° C)

Source: US Department of Agriculture (USDA)

Refrigerate promptly

Refrigerate or freeze meat, poultry, eggs and other perishables as soon as you get them home from

the store.

Keep a constant refrigerator temperature of 40° F or below. The freezer temperature should be 0° F

or below.

Thaw foods in the refrigerator. Do not leave them out to thaw at room temperature.

After cooking, cool foods in the refrigerator. Do not cool them at room temperature.

If your immune system gets weaker, your doctor may ask you to follow stricter guidelines than those

above. You may need to cut out most raw or uncooked fruits and vegetables, cold cuts and processed

meats, raw honey, and unpasteurized products.

Calories and Protein

The suggestions in this booklet may be different from those in the My Plate guidelines. You may be told to

add more of a certain food to increase your intake of calories and protein or to decrease your discomfort

with eating. Your dietitian can help you find an eating plan that works best for you.

Tips for getting the most from your mealsLarge meals can seem overwhelming or unappealing. This can happen when you have a decreased

appetite or feel full shortly after you start eating. The suggestions below can help you get enough calories:

Eat small meals 6 to 8 times a day instead of 3 main meals.

Serve smaller food portions on salad plates instead of dinner plates.

Drink hot chocolate, fruit juices, and nectars that are high in calories.

Avoid low-calorie drinks, such as water, coffee, tea, and diet drinks. Make Double Milk and

milkshakes using the recipes in the “Recipes” section.

Have your favorite snack foods available at home and at work.

Eat your favorite foods at any time of the day. For example, eat breakfast foods such as pancakes or


omelets for lunch or dinner.

Include different colors and textures of foods in your meals to make them more appealing.

Make dining a good experience by eating your meals in a pleasant, relaxing setting with family or

friends.

Smells, such as bread baking or bacon frying, may help boost your appetite.

Tips for adding more protein to your dietYour body needs a balance of calories and protein to function at its best. Your doctor or dietition may tell

you to temporarily increase the amount of protein in your diet. If you recently had surgery or have

wounds, eating more protein will help you heal. The suggestions below will help you increase the amount

of protein in your diet:

Eat foods rich in protein, such as chicken, fish, pork, beef, lamb, eggs, milk, cheese, beans, and tofu.

Drink Double Milk (see the “Recipes” section) and use it in recipes that call for milk or water. You

can use it in instant pudding, cocoa, omelets, and pancake mixes.

Add cheese and diced, cooked meats to your omelets.

Add powdered milk to creamy soups, mashed potatoes, milkshakes, and casseroles.

Snack on cheese or nut butters (e.g., peanut butter, cashew butter, almond butter) with crackers.

Spread nut butters on apples, bananas, or celery.

Try apple slices with cheese wedges and honey drizzled on top.

Blend peanut butter into your chocolate or vanilla shakes.

Snack on roasted nuts and sunflower, pumpkin, or chia seeds.

Try hummus with pita bread.

Add cooked meats to soups, casseroles, salads, and omelets.

Add wheat germ or ground flax seeds to cereals, casseroles, yogurt, and meat spreads.

Eat desserts that are made with eggs. These include angel food cake, puddings, custards, and

cheesecakes.

Add grated cheese to sauces, vegetables, and soups. You can also add it to baked or mashed potatoes,

casseroles, and salads.

Melt cheese on hamburgers and breaded cutlets.

Add chickpeas, kidney beans, tofu, hard-boiled eggs, nuts, and cooked meats or fish to your salads.

Tips for adding more calories to your dietThe suggestions below can help you take in more calories. They may seem to go against what you read and

hear about healthy eating. However, while you are healing, it is more important that you get enough

calories than eat only healthy foods.

Do not eat foods that are fat-free or reduced in fat. Avoid food and drink labels that say “low-fat,”

“non-fat,” or “diet.” For example, use whole milk instead of skim.

Snack on dried fruits, nuts, or dried seeds. Add them to hot cereals, ice cream, or salads.


Drink fruit nectars or fruit shakes.

Add butter, margarine, or oils to potatoes, rice, and pasta. Also add them to cooked vegetables,

sandwiches, toast, and hot cereals.

Add cream cheese to toast or bagels or use it as a spread on vegetables.

Spread cream cheese and jam or peanut butter and jelly on crackers.

Add jelly or honey to breads and crackers.

Mix jam with diced fruit and use it as a topping over ice cream or cake.

Snack on tortilla chips with guacamole. Add avocado slices to your salads.

Use high-calorie dressings on salads, baked potatoes, and on chilled cooked vegetables, such as

green beans or asparagus.

Add sour cream, half and half, or heavy cream to mashed potatoes and cake and cookie recipes. You

can also add it to pancake batter, sauces, gravies, soups, and casseroles.

Top cakes, waffles, French toast, fruits, puddings, and hot chocolate with whipped cream.

Make vegetables or pasta with cream sauces.

Use mayonnaise in salads, sandwiches, and vegetable dips.

Mix granola with yogurt or put it on top of ice cream or fruits.

Top your ice cream or unfrosted cakes with sweetened condensed milk. Combine the condensed

milk with peanut butter to add more calories and flavor.

Add croutons to your salads or omelets.

Include bread stuffing as a side dish with your meals.

Drink homemade shakes. Try the shake recipes in the “Recipes” section. You can also drink high-

calorie, high-protein drinks, such as Carnation® Breakfast Essentials or Ensure®. See the next

section for a list of nutritional supplements you can buy. Or, try the shake recipes in the “Recipes”

section of this resource.

Nutritional Supplements

If you can't make your own shakes, there are many nutritional supplements that you can buy. Some are

drinks that have vitamins and minerals added to them. Most are also lactose-free, which means that you

can have them even if you are lactose intolerant (have difficulty digesting milk products). Check your local

market or drug store to see if they carry any of the brands below.

Nutritional Supplement(Manufacturer)

Description Nutritional Content Comments

Osmolite® 1 Cal (Abbott)Isosource® HN (Nestlé)Glytrol® unflavored (Nestlé)

Bland, unflavored drink.Useful for people who likemild sweetness. Can be usedas a base for mildlysweetened milkshakes.

Per 8-ounce serving:

255 calories and 9 grams of protein

Lactose-freeGluten-freeKosherRefrigerate after opening.

Ensure® (Abbott)Boost® and Boost®

High Protein (Nestlé)

Flavored, sweetened drinkavailable in vanilla,chocolate, strawberry, and



Lactose-freeGluten-freeKosher


High Protein (Nestlé)(Note: some brands are alsoavailable in “Plus” versions)

other flavors, depending onthe brand.

Per 8-ounce serving of “Plus”versions:


Refrigerate after opening.

Glucerna® Shake (Abbott)Boost® Glucose Control(Nestlé)Glytrol® Vanilla (Nestlé)

Low-sugar, liquid supplementfor people with diabetes.Available in vanilla,chocolate, and other flavors,depending on the brand.


190 to 250 calories and 10 grams of

protein

Lactose-freeGluten-freeKosherRefrigerate after opening.

Ensure® Enlive! (Abbott)Ensure® Clear (Abbott)Boost® Breeze (Nestlé)Resource® Diabetishield(Nestlé)

A fruity drink available inpeach, orange, wild berry,iced tea, apple, blueberrypomegranate, and otherflavors, depending on thebrand. Resource®

Diabetishield is for peoplewith diabetes.

Per 8- to 10-ounce serving:

180 to 250 calories and 9 grams of

protein

Per 8-ounce serving ofResource® Diabetishield:

150 calories, 7 grams of protein, and

30 grams of carbohydrates

Fat-freeLactose-freeGluten-freeKosherRefrigerate after opening.

Carnation® BreakfastEssentials™ (Carnation)Scandishake® (Aptalis)

Milk-based, flavored,sweetened powders that canbe mixed with milk or water,depending on the brand.Available in vanilla,chocolate, and strawberry.Carnation® BreakfastEssentials™ is also availablein premixed cans and someflavors are available in sugar-free versions. Scandishake® is available ina lactose-free version.

Per 8-ounce serving ofCarnation® BreakfastEssentials™ with whole milk:280 calories and 12 grams ofprotein Per 8-ounce serving of sugar-free (artificially sweetened)Carnation® BreakfastEssentials™ with whole milk:210 calories and 14 grams ofprotein Per 11-ounce serving ofScandishake® with wholemilk:600 calories and 12grams of protein

Most of these productscontain lactose.The amount of fat perserving is different,depending on the brand.Refrigerate after openingthe liquid formula or aftermixing the powder.

Scandical® (powder)(Aptalis)Benecalorie® (liquid) (Nestlé)Duocal® (powder)(Nutricia)

Unflavored supplement thatcan be mixed into moist foodor drinks for added calories,protein, or both.

Per tablespoon of powder:23 to 35 caloriesPer 1.5 ounces of liquid: 330calories and 7 grams ofprotein

Not for use as a solesource of nutrition.Use under medicalsupervision.

Nepro® (Abbott)Suplena® (Abbott)Novasource® Renal (Nestlé)Renalcal® (Nestlé)

Nutritional supplement forpeople who need to limitpotassium and/orphosphorus in their diet.Available in vanilla, butterpecan, and berry.

Per 8-ounce serving: 425calories and 11 to 19 gramsof protein


Boost® Nutritional® pudding(Nestlé)Ensure® pudding (Abbott)

High-calorie, high-proteinpudding available in vanilla,chocolate, and butterscotch.

Per 4-ounce serving:250 calories and 9 grams ofprotein


Glucerna® Snack Bar(Abbott)Glucerna® Meal Bar (Abbott)

Snack bar for people withdiabetes.

Per bar: 150 to 220 caloriesand 8 to 10 grams of protein

Kosher

Orgain™ (Nutricia) Organic nutritional shakeavailable in sweet vanilla

Per 11-ounce serving: 255calories and 16 grams of

Gluten-freeSoy-free


bean, creamy chocolatefudge, iced café mocha, andstrawberries & cream.

protein 99.3% Lactose-freeKosher

Contact information for buying nutritional supplementsAbbott Nutrition

1-800-258-7677

www.abbottstore.com

Aptalis

1-800-472-2634

http://store.foundcare.com/aptalis

Carnation

1-800-289-7313

www.carnationbreakfastessentails.com

Nestlé

1-800-422-ASK2 (2752)

www.nestle-nutrition.com

Nutricia

1-800-365-7354

www.Nutricia-NA.com

Sample Menus

Use these sample menus to spark your imagination. They can give you ideas for making your own, high-

calorie, high-protein meals at home. You may find it easier to divide a meal into 2 portions so that you

have a small, ready-made meal to eat later in the day. If it is hard for you to make your meals, ask family or

friends for help. Try making meals in batches on days when you have the energy and freeze them for a

later date. You can also eat ready-made foods, if necessary.

Key pointsIf you have diabetes or high blood sugar, use products that are unsweetened or are made with sugar

substitutes. Limit the amount of fruit juice that you drink.

The amount of liquid in the meal plans is small so you don't feel full early during meals. Try to drink

most of your liquids in between your meals. Most adults need 8 to 10 (8-ounce) glasses of liquids per

day. This includes juices, water, milkshakes, and soups. It also includes solids that become liquid at

room temperature such as Italian ices.

If you are lactose-intolerant, you should not drink regular cow's milk. Instead, you should drink

Lactaid® milk, rice milk, almond milk, or soy milk.* Try the sweetened versions of these milks for

extra calories. Take Lactaid® tablets or drops with other dairy foods, such as ice cream or soft

cheeses. People with mild to moderate lactose intolerance can usually handle hard aged cheeses and

yogurt.

Vegetarian and vegan menus are included. Both vegetarians and vegans should eat more nuts, seeds,


http://www.abbottstore.com

http://store.foundcare.com/aptalis

http://www.carnationbreakfastessentails.com

http://www.nestle-nutrition.com

http://www.nutricia-na.com

and oils to increase their calories. Vegans should take special care to eat foods rich in vitamin B12,

calcium, iron, and zinc. Speak with a dietitian if you follow a vegetarian or vegan diet.

Fruits and vegetables are low in calories. Therefore, they are not included in the meal plans often.

You may find that you are not meeting the daily recommended servings. You may need to take a

multivitamin, but check with your doctor first.

See the “Recipes” section for recipes for Double Milk and the shakes listed in the sample menus.

*If you have or have had breast cancer, ask your doctor if it is okay for you to eat foods with soy.

Sample Menu for a Regular DietMeal Regular Diet Regular Diet Regular Diet

Breakfast 1-egg omelette with 1 ounce ofgrated cheese1 small croissant with butterand jelly4 ounces of orange juice

2 small pancakes with butterand syrup4 ounces of pineapple juice

4 ounces of pear nectar1 slice of French toast withbutter and syrup

Mid-morning snack 2 tablespoons of peanutbutter and 1 tablespoon ofjelly on 4 crackers4 ounces of Double Milk

4 graham crackers with¼ cup of cottage cheese andapricot jam4 ounces of Double Milk

8 ounces of peachFruity Shake

Lunch ½ sandwich of grilled turkeyand Swiss cheese on ryebread4 ounces of hot chocolatemade with Double Milk andtopped with whipped cream

½ cheeseburger withmayonnaise and ketchup15 French fries4 ounces of chocolate milkmade with Double Milk

½ cup of macaroni andcheese with extra cheesegrated on top½ cup of cauliflower withbread crumbs sautéed inbutter4 ounces of apricot nectar

Afternoon snack ½ cup of trail mix (mixeddried fruits and nuts)4 ounces of cranberry juice

1 slice of bread with 1 ounceof melted mozzarella cheese4 ounces of pear nectar

8 ounces of fruit yogurt

Dinner 1 (2-inch) slice of quiche½ cup of broccoli with creamor cheese sauce4 ounces of peach nectar

1 (2”x 2”) portion of meatlasagna½ cup of peas with onionsand butter or cream sauce4 ounces of regular soda

2 ounces of steak½ cup of sautéed greenbeans with slivered almonds4 ounces of grape juice

Evening snack ½ cup of super premium*vanilla ice cream topped withchopped pecans, maplesyrup, and whipped cream

½ cup of custard topped withwhipped cream

1 (2-inch) slice of apple piewith 1 ounce of cheddarcheese4 ounces of Double Milk

*Super premium ice cream has about 100 more calories per serving than regular ice cream. It also has

about 20 grams of fat per ½-cup serving.

Sample Menu for a Regular DietMeal Regular Diet Regular Diet Regular Diet

Breakfast 1 egg and cheese omelet withcroutons sautéed in butter4 ounces of orange juice

¾ cup of Frosted Flakes®

cereal4 ounces of Double Milk

1 blueberry pancake withbutter and syrup1 slice of ham4 ounces of hot chocolatemade with Double Milk


Mid-morning snack ½ cup of sugar-coatedroasted peanuts4 ounces of grape juice

2 deviled egg halves4 ounces of pear nectar

¼ cup of pistachios4 dried apricots4 ounces of apple juice

Lunch ½ of a tuna fish sandwichmade with mayonnaise4 ounces of peach nectar

½ of a grilled ham andcheese sandwich4 ounces of chocolate milkmade with Double Milk

1 slice of whole-grain breadtopped with peanut butterand honey4 ounces of Double Milk

Afternoon snack 10 tortilla chips with nachocheese dip4 ounces of regular soda

1 celery stalk filled with creamcheese or herb cheesespread4 ounces of apricot nectar

2 baked stuffed clams4 ounces of grape juice

Dinner Chicken pot pie4 ounces of raspberry FruityShake

2 ounces of fried chicken½ cup of creamed corn½ cup of cheesy mashedpotatoes made with butterand American cheese

1 cup of baked ziti made withwhole-milk ricotta cheese andmozzarella½ cup of broccoli with garlicand oil4 ounces of regular soda

Evening snack ½ cup of rice pudding toppedwith whipped cream4 ounces of Double Milk

Graham cracker “sandwich”with 1 tablespoon of peanutbutter and minimarshmallows4 ounces of chocolateStandard Milkshake

½ cup of super premium icecream topped with chocolatesyrup, nuts, and whippedcream4 ounces of Double Milk

Sample Menu for Regular and Vegetarian Diets

Meal Regular Diet Vegetarian Vegetarian

Breakfast ⅓ cup of granola¾ cup of fruit yogurt4 ounces of apricot nectar

¾ cup of cooked oatmealmade with Double Milk,raisins, walnuts, brown sugar,and butter4 ounces of instant cocoamade with Double Milk

1 slice of whole-grain bread1 ounce of Muenster cheese4 ounces of orange juice

Mid-morning snack A small muffin with butter orcream cheese and jelly4 ounces of Double Milk

½ bagel with vegetablecream cheese4 ounces of strawberry FruityShake

1 cup of Peanut Butter Shake

Lunch 1 (3-inch) wedge of chickenand cheese quesadillatopped with sour cream4 ounces of apple juice

½ of a peanut butter and jellysandwich on whole-grainbread4 ounces of Double Milk

½ of a veggie burger withcheese on a bun with ranchdressing, pickle, and onion15 French fries4 ounces of regular soda

Afternoon snack ½ cup of roasted cashews4 ounces of bananaFruity Shake

½ cup of fruit cocktail with ⅓cup of sour cream and sugarto taste4 ounces of apple juice

4 tablespoons of guacamole8 tortilla chips4 ounces of peach nectar

Dinner 2 ounces of fish baked in ared onion vinaigrette1 small baked potato toppedwith sour cream and chives½ cup of green beans andcarrots with butter4 ounces of cranberry juice

1 (2-inch) slice of broccoli andcheese quiche1 small salad with fetacheese, olives, olive oil, andvinegar4 ounces of ChocolateAlmond Shake

1 cup of fettuccine Alfredo½ cup of spinach sautéed ingarlic and oil4 ounces of grape juice


Evening snack ½ cup of strawberries inheavy cream or half and halfand topped with sugar4 ounces of Double Milk

4 tablespoons of hummus on½ of a toasted pita4 ounces of peach nectar

1 small banana dipped inchocolate syrup and rolled inchopped peanuts½ cup Double Milk

Sample Menu for Vegetarian and Vegan Diets

Meal Vegetarian Vegan Vegan

Breakfast 1 fried egg1 slice of whole-grain breadwith butter and raspberry jam4 ounces of apricot nectar

½ cup of muesli with slices offresh peach4 ounces of soy, rice, oralmond milk

1 soy sausage link2 small pancakes made withsoy milk, margarine, andmaple syrup4 ounces of pineapple juice

Mid-morning snack 4 dried apricots¼ cup of almonds4 ounces of vanilla StandardYogurt Shake

1 cup of dairy-free MapleWalnut Shake½ cup of roasted pistachios

4 ounces of dairy-freeChocolate Cherry Shake

Lunch ½ of a falafel sandwich withextra tahini4 ounces of regular soda

½ cup of linguini with garlicand oil1 soy meatball1 small slice of garlic bread4 ounces of vanilla rice milk

½ soy burger with soy cheeseon a bun with soymayonnaise, ketchup, pickle,and onion15 French fries4 ounces of dairy-free VanillaAlmond Shake

Afternoon snack 4 graham crackers with 2tablespoons of peanut butter4 ounces of Double Milk

4 whole-grain crackers with 2tablespoons of almond butter4 ounces of apricot nectar

½ cup of fruit and nut granola4 ounces of peach nectar

Dinner 1 cup of macaroni andcheese½ cup of chilled asparagustips with blue cheesedressing4 ounces of grape juice

½ cup of tofu and white beancasserole½ cup of brown rice½ cup of sautéed spinachwith roasted pine nuts4 ounces of peach nectar

1 cup of bean chili toppedwith soy cheese1 slice of dairy- and egg-freecorn bread4 ounces of sparkling cider

Evening snack 1 baked apple with cinnamonsugar, butter, and walnuts4 ounces of vanilla soy milk

1 (2-inch) slice of silken tofucheese cake4 ounces of vanilla Dairy-freeMilkshake

½ cup of blueberries toppedwith sugar and non-dairywhipped topping4 ounces of cranberry juice

Recipes

Before you make these recipes, please be aware that raw eggs can cause food poisoning. Do not add

raw eggs to your shakes.

If you have diabetes or high blood sugar, these recipes may not be appropriate for you. Talk with your

dietitian.

Double Milk1 quart of whole milk

1 envelope of non-fat dry milk powder (to make 1 quart of product)

Mix in the blender and refrigerate.

Per 8-ounce serving: 230 calories and 16 grams of protein


Standard Milkshake1 cup of Double Milk described above

2 cups of super premium ice cream (any flavor)

2 tablespoons of sugar or syrup



Standard Yogurt Milkshake (a shake for those who prefer mild sweetness)8 ounces of plain yogurt (use low-fat yogurt if you cannot find regular yogurt)

2 cups of super premium ice cream (any flavor)

4 ounces of Double Milk



Standard Milkshake for People With Diabetes8 ounces of Double Milk

2 cups of sugar-free ice cream (any flavor)

4 teaspoons of canola or olive oil

2 teaspoons of NutraSweet® or other calorie-free sugar substitute (optional)



Standard Dairy-free Shake8 ounces of oat milk, soy milk, or almond milk

2 cups of soy ice cream (any flavor)

4 tablespoons of canola or olive oil

2 tablespoons of maple syrup or sugar (omit this ingredient if you are using sweetened, non-dairy milk)

For vanilla shakes only, add 1 teaspoon of vanilla extract

Mix in blender and refrigerate.


Maple Walnut or Pecan Shake1 cup of Double Milk (described above)

2 cups of super premium vanilla ice cream

¼ cup of maple syrup

½ cup of ground walnuts or pecans



Vanilla or Chocolate Almond ShakeUse vanilla ice cream in the Standard Milkshake recipe and add the following:

½ cup of ground blanched (skinless) almonds

1 teaspoon of vanilla extract (add more sweetener, if desired)

Mix in blender and refrigerate.



OR

Substitute ½ cup of chocolate syrup for the other sweeteners in the Standard Milkshake recipe and add ½

cup of ground blanched almonds.



Peanut Butter ShakeAdd ½ cup of peanut butter to any standard shake recipe.

Substitute ½ cup of sweetened condensed milk or chocolate syrup for the other sweeteners in the

standard shake recipe.


Per 8-ounce serving with peanut butter and sweetened condensed milk: 660 calories and 19 grams of

protein

Per 8-ounce serving with peanut butter and chocolate syrup: 640 calories and 16 grams of protein

Fruity ShakeAdd the following to any standard shake recipe:

1 cup of frozen, fresh, or canned fruit such as strawberries, raspberries, blueberries, bananas, mangoes,

or peaches

You can add more sweetener, depending on how tart the fruit tastes.



Cherry Vanilla or Chocolate Cherry ShakeAdd the following to any standard shake recipe:

1 cup of pitted cherries

½ teaspoon of vanilla extract or substitute ½ cup of chocolate syrup for the sweeteners in the standard

shake recipe


Per 8-ounce serving of Cherry Vanilla: 380 calories and 8 grams of protein

Per 8-ounce serving of Chocolate Cherry: 430 calories and 7 grams of protein

Other shake variationsExperiment with other ingredients after you have tried the shake recipes in this resource. You can use any

of the following ingredients to enhance the flavor of and increase the number of calories in your shakes:

Peanut butter and bananas

Bananas and walnuts

Pineapple and coconut cream*

Oreo® cookies*

M&M's®*

Peanut butter cups*


Flavored liqueurs,* with your doctor's approval and for occasional use only

*If you have diabetes or high blood sugar, these ingredients may not be appropriate for you. Talk with

your dietitian before trying them.

Managing Symptoms and Side Effects Through Nutrition

This section describes some tips you can use to help you with:

Constipation

Diarrhea

Dry or sore mouth

Taste changes

Nausea

Please report any symptoms to your doctor and nurse before following these tips.

ConstipationConstipation is a decrease in your bowel movements. It can include:

Trouble passing stools (feces)

Hard stools

Not being able to empty your bowel

Constipation can be caused by many things, including diet, activity, and lifestyle. Some chemotherapy and

pain medications can also cause constipation. Dietary causes include irregular meals, not eating enough

fiber, and not drinking enough liquids. Fiber is important because it increases the bulk in your stool. This

helps move waste out of your body. Fruits, vegetables, and whole grains have fiber. Below are ways to

manage constipation through your diet.

Eat more high-fiber foods

Add fiber to your diet one food at a time. Be sure to drink enough liquids to prevent gas and bloating.

Examples of high-fiber foods are:

Fruits

Vegetables

Whole grains (e.g., whole-grain cereals, pastas, muffins, breads, and brown rice)

Nuts and seeds

Drink plenty of liquids

Try to drink at least 8 to 10 (8-ounce) glasses of liquids per day. Drink water, fruit and vegetable juices,

milk, and other liquids. This will help keep your stool soft.

Eat at consistent times

Try to eat your meals at the same time each day. If you make changes to your diet, do it slowly.


DiarrheaDiarrhea is frequent, loose, watery bowel movements. It causes food to pass quickly through your

intestines. When this happens, water and nutrients are not absorbed well by your body. Diarrhea can be

caused by:

Chemotherapy

Radiation therapy

Surgery of the stomach or intestines

Medications

Difficulty digesting milk and milk products

Other food sensitivities

Check with your doctor before you use the suggestions below to manage your diarrhea.

Drink plenty of liquids

Drink at least 8 to 10 (8-ounce glasses) of liquids daily. This will help replace the water and nutrients you

lose when you have diarrhea. Try drinking

Water

Fruit juices and nectars mixed with water

Sports drinks like Gatorade®

Clear broth

Unflavored Pedialyte®

Caffeine-free soda. Let the soda sit out uncovered for a few minutes before drinking to reduce the fizz

Avoid very hot or cold, high-sugar, high-fat, and spicy foods. These are hard on your digestive system and

may make your diarrhea worse.

Follow the dietary guidelines below if you are having diarrhea.

Fruits and Vegetables

Foods to tryWell-cooked, peeled and puréed, orcanned fruits and vegetablesBananasPeeled applesJuices or nectars mixed with waterSmooth peanut butter

Most of these items have potassium andliquid to help replace what your body losesfrom diarrhea. They also have soluble fiber,which may decrease diarrhea.

Foods to avoidRaw fruits and vegetables, nuts, andseeds (except those allowed)Vegetables that can cause gas such asbroccoli, cauliflower, cabbage, beans, andonions

Starches and Carbohydrates

Foods to try Foods to avoid


Refined white breads, cereals, rice,pasta, and farinaBoiled or mashed potatoes (without theskins)Crackers, pretzels, and graham crackers

Some of these foods contain salt to helpreplace what your body loses from diarrhea.

Whole-grain breads, pastas, cereals,and brown riceBread products with nuts or seedsFatty breads and pastries, such ascroissants and doughnutsFried potatoes

Meat and Meat Alternatives

Foods to tryLean meats, such as chicken or turkeybreast without skinHard-boiled eggsTofu

These are bland, low-fat, and low-fiber foods.They are easier on your digestive system.

Foods to avoidFatty or fried meats and tofuMeats with skin

These foods are hard on your digestivesystem. They can cause discomfort andmake your diarrhea worse.

Dairy

Foods to tryLow-fat milk or yogurt

If you have problems digesting milk and milkproducts, try Lactaid® milk, soy milk, or ricemilk

Foods to avoidWhole milkIce creamHigh-fat cheesesSour cream

Condiments

Foods to trySalt, unless you must avoid it for otherreasonsFat-free gravies and salad dressings

Foods to avoidLarge amounts of sugar and spicesRich gravies and salad dressingsFoods or drinks with caffeine (e.g.,chocolate, tea, or soda)

These foods are hard on your digestivesystem. This can cause discomfort andmake your diarrhea worse.

Dry or Sore MouthWhen your mouth is dry or sore, eating can be hard or painful. Some foods may be hard to chew and

swallow. A dry or sore mouth can be caused by:

Chemotherapy

Radiation therapy

Medications

Surgery on the head and neck

Infections

Other health problems

A dry and sore mouth may also cause cavities. This is because you are making less saliva, which protects

your teeth against decay.


The types of foods you eat can make a difference. Choose foods that have a moist, soft texture and are

easy to swallow. Avoid foods that are dry or rough. Below is a list of foods you can try.

When Your Mouth Is Dry

Foods to trySoft and puréed foods

Casseroles, bean dishes, macaroni andcheese, and scrambled eggsTender cooked chicken and fishStews and creamed soupsCooked cerealBaby foodSauces, gravies, juices, clear broths,margarine, and sour cream added tofoodsBreads, crackers, and other baked goodsdipped in milk or tea

Cold foods

Milkshakes, smoothies, yogurts, gelatin,cottage cheese, and nutritionalsupplements (see the section “NutritionalSupplements”)Puréed fruits and vegetables

Foods to avoidRough or dry foods

Dry meats without sauceDry, coarse breads, crackers, pretzels,and cerealsCoarse, raw fruits and vegetables


When Your Mouth Is Sore

Foods to tryBland, soft, puréed foods

Plain casseroles, mashed potatoes,macaroni and cheese, and scrambledeggsSoft-cooked or puréed chicken and fishCreamed soupsCooked cerealsBaby food (tapioca and plain flavors)Margarine, sour cream, and mildsauces (as tolerated) added to foodsBreads, crackers, and other baked goodsdipped in milk or tea

Cold foods

Milkshakes, smoothies, yogurts, gelatin,custards, cottage cheese, and nutritionalsupplements

Foods to avoidRough or dry foods

Dry meatsDry breads, crackers, and pretzelsCoarse, raw fruits and vegetablesSpicy, salty, and acidic foodsFoods made with large amounts of spices,such as pepper or chili powderFoods high in salt or made with vinegarCitrus fruit products (e.g., orange juice andlemonade)Tomato products (e.g., pasta sauce,tomato juice, or tomato soup)

The way you eat can make a difference. The following are some tips to avoid irritating your mouth:

Cook your foods until they are soft and tender. Use a blender to purée foods.

Cut your foods into small pieces that are easy for you to chew.

Rinse your mouth out with water often.

Drink liquids with your meals, sipping in between bites.

Use a straw to drink liquid to prevent it from touching your sore mouth.

If you have dry mouth, try sugar-free mints or gum to make more saliva.

Brush your teeth (with the permission of your doctor or dentist) and tongue. Drink more liquids to

help to keep your mouth clean.

Taste ChangesYour sense of taste is made up of 4 main sensations. These are saltiness, sweetness, bitterness, and

sourness. Your sense of taste can be affected by chemotherapy, radiation therapy, and other medications.

Changes in taste vary from person to person. The most common changes are having bitter and metallic

tastes in your mouth. Sometimes, food may not taste like anything.

When your food seems tasteless:

Change the texture of your foods. For example, you may prefer mashed potatoes to baked potatoes

or vice versa. Some foods may taste better cold or at room temperature.

Choose and prepare foods that look and smell good to you.

Use more spices and flavorings as tolerated, for example:

Add sauces and condiments, such as soy sauce or ketchup, to your food.

Marinate your meats or meat substitutes in salad dressings, fruit juices, or other sauces


Use onion or garlic to flavor your vegetables or meats.

Add herbs, such as rosemary, basil, oregano, and mint to your food.

Blend fruit into your milkshakes or yogurt. You can also try mint or coffee-flavored milkshakes.

Try sour and tart foods. These may help stimulate your taste.

If there is a bitter or metallic taste in your mouth:

Rinse your mouth out with water before meals.

Maintain good oral hygiene by brushing your teeth (if your doctor allows it) and your tongue and

drinking more liquids.

If meats taste bitter, try marinating them in sauces or fruit juices.

Include meat substitutes for protein, such as dairy products and beans.

Use plastic utensils to reduce the metallic taste.

Try sugar-free mints or gum.

If foods taste or smell different than usual:

Avoid foods with strong odors. Since beef and fish have the strongest odors, try eating poultry, eggs,

and dairy products.

Experiment with different seasonings and food combinations, such as:

Adding sauces to foods

Changing the temperature and texture of foods

Try adding lemon juice or salt if the food tastes too sweet.

If your mouth is not sore, try tart foods such as lemon wedges or citrus fruits to stimulate taste.

Rinse your mouth out before and after you eat.

Drink small sips of liquid throughout your meals to rinse out the taste of the food.

Maintain good oral hygiene by brushing your teeth (if your doctor allows it) and tongue and drinking

more liquids. Your doctor may also recommend using a mouthwash. This may help you manage

your taste changes.

Check with your doctor or dentist to find out the cause of your taste changes. You should do this before

you make any long-term changes to your diet. If you have any questions or concerns about your dietary

needs, contact a dietitian.

NauseaNausea is a feeling of stomach upset or queasiness. If you have nausea, you may also have vomiting.

Nausea can be caused by radiation therapy, chemotherapy, and surgery. It can also be caused by pain,

medication, and infection. Below are suggestions for managing your nausea through nutrition. Check with

your doctor or nurse before you try any of the tips below. Also, ask your doctor or nurse if you need an

antiemetic. This is a medication to prevent or treat nausea and vomiting.

Foods to Try Foods to Avoid


Starchy, low-fat, bland foodsDry toast, crackers, and bagelsAngel food cake and vanilla wafersSherbet, low-fat ice cream, or frozen yogurtGelatinCanned, unsweetened fruit

Cold foods

Cold proteins such as skinless chicken,cheeses, and yogurtsLight pasta saladsPopsiclesChilled clear liquids, such as broth,nutritional supplements (such as Ensure®)and juices diluted with water

High-fat, overly spicy, or overly sweetfoodsFatty meatsFried foods, such as eggs and French friesSoups with heavy creamCreamed vegetablesHigh-fat, high-sugar pastries,doughnuts, and cookiesFoods made with heavy spices, such aspepper or chili pepper, onion, hot sauce, orsalad dressing

High-fat foods may stay in your stomachlonger and are harder to digest. Many ofthese foods have strong odors or flavors thatcan cause nausea or make it worse.

General tips

Pay attention to the amount of food you eat.

Try convenience foods to prevent nausea while you cook or prepare foods. If you need to, ask others

to cook for you.

Eat small, frequent meals. This can stop you from getting too full and allow you to take in more food

throughout the day.

Drink most liquids in between your meals to prevent feeling full too fast or bloated.

Eat slowly and chew your foods well to help with digestion. Avoid activity right after meals.

Eat your meals in a pleasant setting. Choose a relaxing place that has a comfortable temperature.

Avoid places with strong odors. Eating with friends or family may also help distract you from your

nausea. Wear loose-fitting clothing to stay comfortable.

If you experience nausea in the morning, keep crackers or dry toast at your bedside. Eat these before

getting out of bed.

Avoid eating your favorite foods right before or after treatments. You may begin to dislike these

foods.

If nausea is an ongoing problem for you, it may be useful to keep a food diary. This is a record of the foods

you eat, the time you ate them, and the setting in which you ate them. Record any situations when you

became nauseous. Discuss this with your doctor, nurse, or dietitian.

FatigueFatigue is the most common side effect of cancer and cancer treatments. It may prevent you from doing

your daily activities. It may also impact your quality of life and decrease your tolerance to treatment.

Fatigue can be caused by many symptoms, such as:

Poor appetite

Depression

Nausea and vomiting


Diarrhea or constipation

Relief of these symptoms can give you more energy. It can also increase your feeling of well-being.

Another option is to save your energy. You can do this by

Aasking family and friends for help with shopping and preparing your meals.

Buying already prepared or takeout foods when your energy is low.

Keeping ingredients and utensils that you use often close at hand.

Sitting instead of standing when cooking.

Eating small, frequent, high-calorie meals or snacks so that your body may not need as much energy

to digest your food.

If you live alone and are not able to shop for food or prepare meals, you may be eligible for food

programs, such as God's Love We Deliver or Meals on Wheels. There may be age or income

requirements for some programs. Your social worker can give you more information.

Engaging in physical activity may actually increase your energy levels. Talk with your doctor about doing

light-to-moderate intensity activities like walking or gardening. Research shows that some physical activity

can improve your daily functioning, boost your energy level, stimulate your appetite, and enhance your

mood.

MedicationWhile diet changes can help, medication may be needed to manage your side effects. Medication can help

with nausea, diarrhea, and constipation. Tell your doctor or nurse about any side effects you have during

your treatment.

After Your Cancer Treatment Ends

When your cancer treatment is finished, it is a good time to think about making good food choices. You

will want to make choices that promote health and well-being. Select foods low in fat and rich in vitamins,

minerals, fiber, and phytochemicals. Phytochemicals, also known as phytonutrients, are plant substances

that may protect against cancer. Examples of phytochemicals include lycopene in tomatoes, curcumin in

tumeric, and resveratrol in grape skins.

Diet is linked to health. There is no evidence that the foods you eat will prevent your cancer from coming

back. But, eating the right foods will help you regain your strength, rebuild tissue, and feel your best. The

following tips may help:

Include many kinds of fruits and vegetables in your diet to make sure you get many different

nutrients. You can eat fruits and vegetables cooked or raw at any time of the day. Be sure to eat more

of the non-starchy vegetables. These include artichokes, artichoke hearts, asparagus, beans (green

wax, Italian) bean sprouts, beets, broccoli, Brussels sprouts, cabbage, carrots, cauliflower, celery,

cucumber, eggplant, green onions (scallions), kohlrabi, leeks, mushrooms, okra, onions, peppers,

radishes, salad greens (endive, escarole, iceberg lettuce, romaine, green and red leaf lettuce, spinach),

summer squash, tomatoes, turnips, water chestnuts, watercress, and zucchini. Starchy vegetables,

such as corn, greens peas, plantains, potatoes, winter squash (acorn butternut, pumpkin), and yams


are also good to eat and should be served with the foods listed above.

Eat whole-grain breads and cereals. Select high-fiber foods, such as bran and shredded wheat

cereals, brown rice, and multigrain, whole wheat, and oat breads. Try different grains, such as barley,

buckwheat, and bulgur.

Legumes are also an excellent source of fiber and nutrients. They include beans and peas (chickpeas,

pinto, kidney, white, split, black-eyed, and lima), lentils, and miso (thick soy paste).

Limit your intake of fat, salt, sugar, alcohol, and smoked, cured, or pickled foods.

Choose low-fat milk products, lean meats, poultry without skin, and baked fish.

Prepare meals using lower-fat cooking methods such as broiling, steaming, and poaching.

Resources

Academy of Nutrition and Dietetics (AND)

www.eatright.org/public

AND is a professional organization for registered dietitians. To find a registered dietitian in your area, click

on “Find a Registered Dietitian” in the upper right corner of the website home page.

American Institute for Cancer Research

www.aicr.org

1-800-843-8114

Includes information on diet and cancer prevention.

FDA Center for Food Safety and Applied Nutrition

www.fda.gov/AboutFDA/CentersOffices/OfficeofFoods/CFSAN/default.htm

Includes helpful information on food safety.

MSK Integrative Medicine Service

1-800-525-2225

www.mskcc.org/cancer-care/integrative-medicine

Integrative Medicine Service offers patients many services to complement traditional medical care,

including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy.

National Institutes of Health Office of Dietary Supplements

http://ods.od.nih.gov

(301) 435-2920

Has up-to-date information on dietary supplements.

If you have any questions or concerns, talk with a member of your healthcare team. You can reach

them Monday through Friday from 9:00 am to 5:00 pm at ____________________. After 5:00

pm, during the weekend, and on holidays, please call____________________. If there’s no

number listed, or you’re not sure, call (212) 639-2000.

©2015 Memorial Sloan Kettering Cancer Center - Printed on May 6, 2015, 12:34 pm [B-160]


http://www.eatright.org/public

http://www.aicr.org

http://www.fda.gov/AboutFDA/CentersOffices/OfficeofFoods/CFSAN/default.htm

http://edit.mskcc.org/cancer-care/integrative-medicine

http://ods.od.nih.gov

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